FORM 1023-EZ for BUTTERFLIES & ROSES CANCER SUPPORT

Field Data
EIN 83-1334477
Case Number EO-2018260-000442
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name BUTTERFLIES & ROSES CANCER SUPPORT
Organization’s Mailing Address 12131 FRANCIS
City GRASS VALLEY
State CA
ZIP 95949
Accounting period End 12
Primary contact name ROBERT PELLERINO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERT PELLERINO
DIRECTOR AND PRESIDENT
12131 FRANCIS DR
GRASS VALLEY CA 95949

Officer/Director/Trustee Two

LYNN COSTA
DIRECTOR AND TREASURER
10185 WEBER ST
GRASS VALLEY CA 95949

Officer/Director/Trustee Three

MELEESA PELLERINO
DIRECTOR
12131 FRANCIS DR
GRASS VALLEY CA 95949

Officer/Director/Trustee Four

MATT MULLEN
DIRECTOR
13266 MOCCASIN LN
SHASTA LAKE CITY CA 96019

Officer/Director/Trustee Five

LAURIE MULLEN
DIRECTOR
13266 MOCCASIN LN
SHASTA LAKE CITY CA 90619

Organization’s website BUTTERFLIESANDROSES.ORG
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 7/10/18
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E86 - Patient Services - Entertainment, Recreation
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers Yes
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name ROBERT PELLERINO
Signature Title DIRECTOR AND PRESIDENT
Signature Date 9/14/18

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